In one of the most moving passages in the book,
Gawande’s father, in hospice, rises from his wheelchair to hear his son lecture
at their hometown university. “I was almost overcome just witnessing it,”
Gawande writes.

........Gawande offers no manifesto, no checklist, for
a better end of life. Rather, he profiles professionals who have challenged the
status quo, including Bill Thomas and other geriatricians, palliative-care
specialists, and hospice workers. Particularly inspiring are the stories of
patients who made hard decisions about balancing their desire to live longer
with their desire to live better. These include Gawande’s daughter’s piano
teacher, who gave lessons until the last month of her life, and Gawande’s father,
also a surgeon, who continued work on a school he founded in India while
dying of a spinal tumor.

He’s awed not
only by his father’s strength, but by the hospice care that helped the dying
man articulate what mattered most to him, and to do it. Gawande thinks, as he
watches his proud father climb the bleachers, “Here is what a different kind of
care — a different kind of medicine — makes possible.”

What would lawyers say about M + M:

- ‘There is one place, however, where doctors can talk candidly about their mistakes, if not with patients, then at least with one another. It is called the Morbidity and Mortality Conference – or, more simply, M+M – and it takes place, usually once a week, at nearly every academic hospital in the country. This institution survives because laws protecting its proceedings from legal discovery have stayed on the books in most states, despite frequent challenges.’ >>>See also Dr No: We Have No Black Boxes

The Cockroach Catcher was finishing reading the book Complications and such charming old landscape reminds him of the old traditional medical training he received and how some doctors still do. Like the author of this book.

The book reads more like a collection of blog posts and in fact it was. Yet it was real and touching. Sometimes it was brunt and brutal. and after all doctors are as human as anyone. Complications includes those doctors themselves may suffer: mental illness and alcoholism as well as the serious cardiac condition of the author's young son.

We, doctors make mistakes and please we must be allowed to sort them out without affecting career or worst, future medical behaviour.

A great book for doctors in particular and when on holiday in a charming place.

(Metropolitan Books, 288 pages, $24), a collection of 14 pieces, some of which were originally published in The New Yorker and Slate magazines, Gawande uses real-life scenarios – a burned-out doctor who refuses to quit; a terminal patient who opts for risky surgery, with fatal results – to explore the larger ethical issues that underlie medicine. He asks: How much input should a patient have? How can young doctors gain hands-on experience without endangering lives? And how responsible are these doctors for their mistakes?

While “Complications” is full of tragic errors and near misses, the book is not intended to be an expose. Rather, Gawande asserts, it is meant to deepen our understanding of the intricacies of medicine. “In most medical writing, the doctor is either a hero or a villain,” he says, with an edge in his voice. “What I am trying to do is push beyond that and show how ordinary doctors are – and at the same time show that what they can do is extraordinary.”

John Freeman, Copyright (c) 2002 The Denver Post.

Quotes- ‘There have now been many studies of elite performers – international violinists, chess grand masters, professional ice-skaters, mathematicians, and so forth – and the biggest difference… is the cumulative amount of deliberate practice they’ve had.’- ‘We have long faced a conflict between the imperative to give patients the best possible care and the need to provide novices with experience. Residencies attempt to mitigate potential harm through supervision and graduated responsibility. And there is reason to think patients actually benefit from teaching. Studies generally find teaching hospitals have better outcomes than non-teaching hospitals. Residents may be amateurs, but having them around checking on patients, asking questions, and keeping faculty on their toes seem to help. But there is still getting around those first few unsteady times a young physician tries to put in a central line, remove a breast cancer, or sew together two segments of a colon… the ward services and clinics where residents have the most responsibility are populated by the poor, the uninsured, the drunk, and the demented… By traditional ethics and public insistence (not to mention court rulings), a patient’s right to the best care possible must trump the objective of training novices. We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So learning is hidden behind drapes and anesthesia and the elisions of language.’ - ‘There is one place, however, where doctors can talk candidly about their mistakes, if not with patients, then at least with one another. It is called the Morbidity and Mortality Conference – or, more simply, M+M – and it takes place, usually once a week, at nearly every academic hospital in the country. This institution survives because laws protecting its proceedings from legal discovery have stayed on the books in most states, despite frequent challenges.’

Monday, November 24, 2014

The boy of this American doctor had tears in
his eyes and so did I when I read the following blog.

The media must have worked so hard that even an intelligent doctor from America
thought she would have to wait 18 hours at our A&E. That is not surprising given the
latest pre-NHS sale pitch is that the wait is over 35 hours.

Fearing that her son was faking she offered
what The Cockroach Catcher would have offered: A&E or Toy.

You know it’s going to be one of those days when one
of the first tweets on vacation inquires about the closest hospital.

Victor, one of my 11-year-olds, had something in his
eye courtesy of a big gust of wind outside of Westminster Abby. He was complaining enough to
let me flip his eyelid and irrigate his eye on the square in front of Big Ben.
(I’m sure several people thought I was torturing him). Despite an
extensive search and rinse mission no object or relief was to be found. I
fretted about going to the hospital. It wasn’t the prospect of navigating a
slightly foreign ER, but simply the prospect of the wait. While I am a staunch
supporter of the British NHS in the back of my mind I envisioned
a paralyzingly full emergency room and an agonizing 18 hour wait only to
find he had nothing in his eye (the basic antechamber of Hell scenario). To
ensure we really needed to go I gave Victor a choice between the emergency room
and a toy store (Gunter’s 3rd rule), but he declined the toys so off we went to
St. Thomas
hospital, conveniently right over the bridge.

.................................................>>>>>>

Her blog post attracted over 799 comments and is still going strong.

So we again offered world class medicine without knowing.

Just look at the faith we have in our A&E departments to the point that Roy Lilly suggested:

There is even argument that GPs cannot do A&E work and A&E doctors cannot do GP work. What has gone wrong with medical training?

There is a very discrete attempt to change the name of A&E to ED.

Wow! Do people never learn from history?

No!!! NHS and A&E. Original please

So if politicians have not been so interfering and allow us doctors, nurses and patients to make things work together we may indeed have a better NHS. All the analysis on the reform is clear about one thing: someone is going to make money and that means less money for actual health care.

NHSThe PLOT to kill off the NHS Original started with Fundholding and since then every single government tried! Often in the name of improving health care.

The NHS has its faults but the fixing of it is not by bringing in privateers as they will be gaming for public money; nor would competition and choice work. We only need to look at the number of times the average household change utility providers.

But the government is pretending that Southern Cross would go away very quickly. The same with Four Seasons. We have no idea if there were any secret behind the scene deals so that the likes of Southern Cross will not hit the headlines as the HCSB tried to wriggle through parliament.

No we want the old NHS!!! NHS Classic!!! NHS Original!!! No mercury or manganese please.

Perhaps politicians can learn from this: you can say all the bad things about the NHS and you can quote how badly we are doing but we still love our NHS for all its short comings and perhaps if politicians have not been so interfering and allow us doctors, nurses and patients to make things work together we may indeed have a better NHS. All the analysis on the reform is clear about one thing: someone is going to make money and that means less money for actual health care.

Because, reading between the lines, that is what it is. If government can have its way the ordinary citizens who cannot afford health care insurance will get inferior care in a society that needs to ration its skilled medical professionals. It is no good trying to pretend it is any other way.

Our generation had the best of the NHS. We had the best of the welfare state including free education, free health care and above all freedom from fear of health care bills. Now it is up to your generation to fight for what we are in danger of destroying. The BMA are considering taking a legal challenge against the government, you should add your voices. Ultimately the battle for the NHS is a political battle and unless you make your voices heard then the NHS will be lost. Not one citizen in England can afford to lose their NHS; the scale of the public health casualties will be too great if the Bill is passed. The abolition of the NHS should not be our legacy to your generation for how can you care properly in the knowledge that so many will go uncared for. Its your NHS but only for so long as you care enough to fight for it.NHS A&E: Unpredictable, Unruly & Ungainly

Saturday, November 15, 2014

More than just spectacular scenery, JiuzhaiValleyNational
Park is home to nine Tibetan villages, over 220 bird species
as well as a number of endangered plant and animal species, including the giant
panda, Sichuan golden monkey, the Sichuan takin and
numerous orchids and rhododendrons.

JiuzhaiValley is locally known as Jiuzhaigou
(Chinese for “NineVillageValley”).
It is a national park located in the Min Shan mountain range, Northern
Sichuan in South Western China. It is best known for its fabled
blue and green lakes, spectacular waterfalls, narrow conic karst land forms and
its unique wildlife. It was declared a UNESCO World Heritage Site in 1992; the
park joined the Man and Biosphere Conservation Network in 1997 and has also
received IUCN and ISO 14,001 accreditations.

It is China’s
premier national park and is located at elevations ranging between 1,990m
(6,529 feet) to 4,764m (15,630 feet) above sea level. Located on the edge of
the Tibetan Himalayan Plateau in NorthernSichuanProvince
it is easily accessible by direct flights from Beijing,
Shanghai, Xian, Chengdu,
Chongqing and Hangzhou. JiuzhaiValley provides spectacular scenery
throughout the year making it one of China’s most treasured scenic
sites.

Thank you for your visit.

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A budding child psychiatrist

About Me

Before my retirement, I practised child psychiatry for 30 years, 25 of which as a consultant and director. After these years of clinical practice, I felt compelled to tell my stories as I have my doubts as to the validity of some of the assertions of the medical world.
I am the author of the book The Cockroach Catcher, which is based on my work as an NHS child psychiatrist. Contact me on: cockroachcatcher at gmail dot com

Eric Kandel, M.D., who was awarded the Nobel Prize in 2000 for discovering molecular mechanisms of memory storage, told the crowd at last ...

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